Cognitive Behavioral Therapy Supervision Research Articles

Maladaptive therapist schemas in CBT practice, training and supervision: A scoping review.

Maladaptive therapist schemas are hypothesized to generate difficulties within cognitive behavioural therapy (CBT) practice, training and supervision. Without adequate identification and management, they negatively affect the cognitions and emotions of the therapist, leading them to behave in ways that risk ruptures or therapy and supervision being delivered in a suboptimal fashion. Consequently, there is a need to synthesize the research that has been undertaken to date on the content, prevalence, identification and management of maladaptive therapist schemas. A scoping review was undertaken of studies that have been published since 2001 on the impact of maladaptive therapist schemas (also referred to interchangeably as beliefs or cognitions) in CBT practice, training and supervision. Thirteen studies were identified in a literature search from four electronic databases, a reference list search of identified articles and hand searches. Three overall themes were identified in the research: (1) prevalence of therapist schemas, (2) specific therapist beliefs and (3) therapist characteristics associated with the delivery of suboptimal CBT or supervision. While there is little empirical support for therapist schemas, therapist resistance and beliefs relating to the fear of using exposure therapy were identified. Therapist intolerance of uncertainty and self-esteem were recurrent factors. There is no consensus on how to define, identify, formulate or respond to maladaptive therapist beliefs or schemas in clinical practice, training or supervision. Further research is needed to better understand their origins, maintaining factors and appropriate management of their impact.

Technological Advances in Cognitive-Behavioral Therapy and Clinical Practice: Challenges in an Evolving Field.

Technological innovations in cognitive-behavioral therapy (CBT) provide excellent opportunities for mental health clinicians to expand access to mental health treatment among culturally diverse and marginalized populations. This brief report highlights challenges that mental health clinicians encounter as they integrate technological innovations in CBT into their work with diverse clients and provides recommendations for addressing them. The authors identify five key challenges of using technology-driven CBT: development of the therapeutic alliance; potential fit for clients from culturally diverse backgrounds and marginalized groups; geographic and economic access; ethical and legal concerns; and competency in CBT practice, training, and supervision. Technological advances in CBT allow clinicians to treat more individuals from underserved communities. Existing challenges compel clinicians across disciplines to ensure that their practice is congruent with CBT practice values and ethics, policy, and research and that the best available CBT intervention can be integrated into all aspects of mental health practice.

Psychometric properties of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) in a Turkish sample.

Cognitive behavioural therapy (CBT) training is highly demanded by clinicians; however, a standardized competence assessment for professionals working with children and young people (CYP) can be problematic. Psychometric tools used for this purpose are typically adult oriented measures. The present study provides psychometric properties of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) derived from a comparative analysis with the Cognitive Therapy Scale (CTS). The CBTS-CYP was used alongside CTS in a CBT supervision training course, consisting of a cohort of 51 therapists. A total of 36 audio/video recorded full CBT sessions were assessed for the purpose of determining CBT competence and adherence to the theory and model. The training involved a total of 80 hours of supervision in 10 meetings via an online videoconferencing platform between July 2020 and February 2021. Face validity and inter-rater reliability of CBTS-CYP were high, with the intraclass correlation values being good (0.60-0.74) or excellent (0.74 and above); the correlations of each CBTS-CYP and CTS items were significant; internal consistency of the scale showed that Cronbach alpha values for total-scale and its two subdimensions were above .93. For a cut-off score of 55 out of 90, sensitivity reached 90.73% and specificity 90.73%. A score of 2 points or above from any single item could be considered as the second minimum criterion for competence. CBTS-CYP offers a valid and reliable scale to evaluate the competence and adherence quality of CBT sessions with children and adolescents.

REBT 인지행동치료 슈퍼비전의 실제

The purpose of this study is to provide a theoretical basis and practical help for the implementation of domestic cognitive behavioral therapy supervision by reviewing the studies centered on competence enhancement and competency evaluation of supervisors, which are the core emphasis in the practice of cognitive behavioral therapy supervision. To this end, this study introduced the practice of capacity building and evaluation based on several studies that verified inter-rater reliability and validity of evaluation tools for cognitive behavioral therapy supervision. The conclusion is as follows. First, competency reinforcement used in cognitive behavioral therapy supervision is basically divided into basic competency and functional competency, and helps to perform high quality psychotherapy and supervision. Second, representative measurement tools for evaluating the competence of cognitive behavioral supervision are SAGE(Supervision: Adherence and Guidance Evaluation) and CTS-R(Revised Cognitive Therapy Scale). In the future, for domestic use of SAGE and CTS-R, additional processes such as understanding of evaluation tools, ethical aspects, evaluator training, and securing reliability are thought to be necessary. In addition, if continuous exploration and training are conducted for the development of domestic cognitive behavioral therapy research, it is believed that it will be of great practical help to the qualitative growth and development of supermarkets.

REBT 인지행동치료 슈퍼비전의 실제

The purpose of this study is to provide a theoretical basis and practical help for the implementation of domestic cognitive behavioral therapy supervision by reviewing the studies centered on competence enhancement and competency evaluation of supervisors, which are the core emphasis in the practice of cognitive behavioral therapy supervision. To this end, this study introduced the practice of capacity building and evaluation based on several studies that verified inter-rater reliability and validity of evaluation tools for cognitive behavioral therapy supervision. The conclusion is as follows. First, competency reinforcement used in cognitive behavioral therapy supervision is basically divided into basic competency and functional competency, and helps to perform high quality psychotherapy and supervision. Second, representative measurement tools for evaluating the competence of cognitive behavioral supervision are SAGE(Supervision: Adherence and Guidance Evaluation) and CTS-R(Revised Cognitive Therapy Scale). In the future, for domestic use of SAGE and CTS-R, additional processes such as understanding of evaluation tools, ethical aspects, evaluator training, and securing reliability are thought to be necessary. In addition, if continuous exploration and training are conducted for the development of domestic cognitive behavioral therapy research, it is believed that it will be of great practical help to the qualitative growth and development of supermarkets.

Embedding the silver thread in all-age psychological services: training and supervising younger therapists to deliver CBT for anxiety or depression to older people with multi-morbidity

Abstract Providers of cognitive behavioural therapy (CBT) in adult mental health services in the UK are expected to deliver therapy suitable for adults of all ages. However, older people commonly present with co-morbidities that challenge delivery of single-diagnosis CBT protocols. Added to this, the difference in age between therapy-provider and service-user can compromise collaboration. In this paper, I consider two key areas of relevance for training and supervising CBT therapists for work with older people, namely multi-morbidities and intergenerational relations. The evolving evidence base for CBT with older people is summarised and a commentary provided on previous ‘old age’ case studies from the Cognitive Behaviour Therapist (tCBT). Strategies for collaborative relationships are discussed, as are strategies for ‘embedding the silver thread’. I conclude with recommendations for future directions for CBT training and supervision. Key learning aims (1) To be aware that any differences in working with older people are not due to age per se, but factors such as cohort differences and multi-morbidity. (2) To reflect on case examples of CBT with older people. (3) To learn strategies for developing collaborative relationships across an intergenerational divide.

Knowledge and Attitudes Toward an Artificial Intelligence-Based Fidelity Measurement in Community Cognitive Behavioral Therapy Supervision.

To capitalize on investments in evidence-based practices, technology is needed to scale up fidelity assessment and supervision. Stakeholder feedback may facilitate adoption of such tools. This evaluation gathered stakeholder feedback and preferences to explore whether it would be fundamentally feasible or possible to implement an automated fidelity-scoring supervision tool in community mental health settings. A partially mixed, sequential research method design was used including focus group discussions with community mental health therapists (n = 18) and clinical leadership (n = 12) to explore typical supervision practices, followed by discussion of an automated fidelity feedback tool embedded in a cloud-based supervision platform. Interpretation of qualitative findings was enhanced through quantitative measures of participants' use of technology and perceptions of acceptability, appropriateness, and feasibility of the tool. Initial perceptions of acceptability, appropriateness, and feasibility of automated fidelity tools were positive and increased after introduction of an automated tool. Standard supervision was described as collaboratively guided and focused on clinical content, self-care, and documentation. Participants highlighted the tool's utility for supervision, training, and professional growth, but questioned its ability to evaluate rapport, cultural responsiveness, and non-verbal communication. Concerns were raised about privacy and the impact of low scores on therapist confidence. Desired features included intervention labeling and transparency about how scores related to session content. Opportunities for asynchronous, remote, and targeted supervision were particularly valued. Stakeholder feedback suggests that automated fidelity measurement could augment supervision practices. Future research should examine the relations among use of such supervision tools, clinician skill, and client outcomes.

Deepening the Group Training Experience: Group Cohesion and Supervision Impact in Alliance-Focused Training.

The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact. Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis. All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience. Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.

Clinical supervision in CBT training: what do participants view as effective?

AbstractLiterature pertaining to cognitive behavioural therapy (CBT) supervision is limited, particularly about CBT supervision during training. This exploratory study outlines the thoughts of supervisors and supervisees in a training context about which elements make supervision effective. Four supervisees and four experienced CBT supervisors (all from a CBT training programme and independent of one another) were interviewed and asked to consider what makes CBT supervision during training effective. Their responses were evaluated using thematic analysis (TA) and key themes identified. The fit with existing literature was considered via the use of an adapted Delphi poll. Two main themes, containing seven subthemes, were identified from the thematic analysis: ‘supervision as structured learning’ and ‘supervisory relations and process’. The adapted Delphi poll was divided into six categories denoting important characteristics of CBT supervision: (1) the supervisory relationship, (2) ethical factors, (3) generic supervisory skills, (4) mirroring the CBT approach, (5) the supervisor’s knowledge and (6) addressing difficulties. There was a good fit between the TA themes and the Delphi categories. For those engaging in CBT supervision, establishing a structure that mirrors a CBT session, alongside a supportive supervisory alliance, may promote effective CBT supervision during training.Key learning aims(1)To consider what might make CBT supervision during training a better experience for participants, such as alliance factors and structured learning.(2)To discover how supervisors’ and trainees’ perspectives fit with existing research on CBT supervision.(3)To consider some potential supervisory implications related to aspects of CBT supervision that participants find useful.

Preventing harm related to CBT supervision: a theoretical review and preliminary framework

AbstractLike any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.

Can we agree on the quality of clinical supervision? Inter-rater reliability of the Short–SAGE (Supervision: Adherence and Guidance Evaluation) scale

Abstract Clinical supervision is a cornerstone in psychotherapist training, but research in this area is hampered by a lack of validated tools for assessing supervision quality. Short–SAGE (Supervision: Adherence and Guidance Evaluation) is an observational instrument designed for evaluating supervision in cognitive behavioural therapy. The aim of this study was to evaluate the inter-rater reliability of Short–SAGE. Four experienced clinical psychologists participated in three 3-hour Short–SAGE coding training sessions, followed by an additional meeting and coding instructions. In a cross-over design, codings of 20 supervision sessions were then assessed with intraclass correlations (ICC), for both the 3- and 7-point scales of the instrument. In the single measure analyses for both scales, only one item showed ICC in the good range, and the rest of the 14 item ICCs were in the poor to fair range. Moreover, on the 3-point scale, five of the 14 inter-rater correlations were non-significant. For research and training purposes, validated tools to assess supervision quality are highly needed. However, instruments for measuring adherence and/or competence are of little value if the coders do not attain inter-rater reliability. Whether quality of supervision is associated with improvements in supervisees’ competencies is not yet clear. Short–SAGE provides a tool that may enable empirical research in this area. Further studies are needed to assess whether extensive training can improve the inter-rater reliability of Short–SAGE. Key learning aims (1) Readers will be aware of the urgent need for validated tools to assess clinical supervision quality. (2) Readers will be familiar with some existing tools for assessing the quality of clinical supervision. (3) Readers will be able to identify common problems in the development of instruments for assessing clinical supervision.

Graduate school training in CBT supervision to develop knowledge and competencies

ABSTRACT Cognitive behavioral therapy (CBT) is the dominant training model adopted by clinical psychology training programs and is commonly reported as the primary theoretical orientation among community therapists. However, few American psychologists receive formal training in supervision to support CBT, despite APA recommendations related to supervision competencies. Graduate training is an optimal time and place for supervision training, and we describe a CBT supervision workshop within a clinical doctoral program. Twenty-three trainees (69.6% Caucasian/White, 73.9% women) reported declarative knowledge of supervision and perceived supervision competencies before and after the workshop. Trainees increased declarative knowledge and perceived supervision competencies. Graduate training in CBT supervision may help develop a well-trained supervisor workforce that can better support the use of evidence-based therapies, such as CBT.

Cognitive Behavioral Therapy in Choking Phobia: Case Report

Choking phobia (or swallowing phobia) is a disorder which defined as a fear and avoidance of swallowing food, drinks or pills. his study includes the process of the case formulation and cognitive behavioural therapy supervision which is addressed at the end of 27 sessions of a patient with choking phobia and panic attacks. Patient is 25 years old, university graduated, female with a profession. Patient recoursed with the complaints of choking thoughts while eating, panic attacks and trust issues she experiences in her romantic relationships. During the therapy process which has been composed within the framework of cognitive behavioral therapy; cognitive restructuring techniques, relaxation exercises, systematic desensitization, coping cards and psycho-education methods were utilized. At the end of the process, it was observed that the patient is able to consume food and drinks that she could not consume before the treatment, her choking anxiety while eating and drinking has disappeared. Moreover, she is able to eat in different social environments which was not possible before, her panic attacks did not repeate and in particular the cognitive distortions which are affected her romantic relationships decreased. In the follow-up interview it was observed that well-being has maintained. It is thought that this case study will contribute studies about choking phobia which are few in the literature. The findings should be strengthened by applying appropriate cognitive behavioral techniques to other cases.

Therapist adherence and therapeutic alliance in individual cognitive-behavioural therapy for adolescent binge-eating disorder.

To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N=64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.

An improved competence rating scale for CBT Supervision: Short-SAGE

AbstractRecent developments have led the UK government to deem clinical supervision ‘essential’ to a safe and effective national health service. Cognitive behavioural therapy (CBT) supervision has been increasingly operationalized and manualized, but there are few psychometrically sound observational instruments with which to measure CBT supervision. This paper reports the factor analysis of a promising 23-item instrument for observing competence in CBT supervision (Supervision: Adherence and Guidance Evaluation: SAGE).N=115 qualified mental health practitioners (supervisors and their supervisees) rated the same supervision session by completing SAGE. A principal components analysis indicated that a two-factor solution, identified as the ‘Supervision Cycle’ and the ‘Supervisee Cycle’ components, accounted for 52.8% of the scale variance and also demonstrated high internal reliability (α = .91 and α = .81, respectively). These findings provide the basis for a shorter, 14-item version of SAGE, clarify the factor structure of SAGE, ease implementation, and afford more succinct feedback. Short-SAGE also improves implementation yield, taking half the time to complete as the original 23-item scale. These conceptual and practical improvements strengthen the role of SAGE as a promising observational instrument for evaluating CBT supervision, complementing self-report assessments of competent CBT supervision with an instrument that can fulfil the distinctive functions that are provided through direct observation.

How Supervisees on a Foundation Course in CBT Perceive a Supervision Session and what they Bring Forward to the Next Therapy Session.

There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees' perspective. The aim of the study was to acquire knowledge from the supervisees' perspective as to what in particular in the supervision process contributes to the therapy process. Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants' written diaries after supervision and therapy sessions. Analyses of supervisees' experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was 'doing the right thing' was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.

The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review

BackgroundClinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees’ competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy.MethodsThis study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees’ patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically.DiscussionThis systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.Systematic review registrationPROSPERO CRD42016046834

Basic principles of supervision and its ethics in cognitive behavioral therapy

BackgroundSupervision is the systematic guidance of a therapist by a supervisor. It is a basic part of training and ongoing education in cognitive behavioral therapy (CBT). Self-reflection and ethical reflection are an important part of supervision.MethodThe Pubmed database was searched for articles using the keywords supervision in CBT, therapeutic relations, ethics, transference, counter transference, schema therapy, dialectical behavioral therapy, acceptance and commitment therapy.ResultsWe discuss conceptual aspects related to supervision and the role of self-reflection and ethical reflection. The task of supervision is to increase the value of the therapeutic process in the client's best interest. Establishing the supervisor-supervisee relationship is based on principles similar to those in the therapeutic relationship. Additionally, supervision is oriented towards increasing the therapist's competencies. The CBT therapist's core competencies involve good theoretical knowledge, professional behavior towards clients, ability to use specific therapeutic strategies for maintaining the therapeutic relationship, sensitivity to parallel processes and accomplishment of changes, and adherence to ethical norms. Given the fact that during supervision, the supervisee may be at any stage of his/her training, supervision must take into consideration where the therapist is in his/her training and development and what he/she has or has not learnt.ConclusionsBoth the literature and our experience underscore the importance of careful supervision of cognitive behavioral therapy. Numerous approaches are used in supervision, which is associated with the abilities to self-reflect and to realize transference and counter transference mechanisms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

"Is supervision necessary? Examining the effects of Internet-based CBT training with and without supervision": Correction to Rakovshik et al. (2016).

Participants were randomized into 3 conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW); (2) Internet-based training with CBT supervision via Skype (IBT-S); and (3) "delayed-training" controls (DTs), who did not receive the training until all data collection was completed. The IBT participants received access to training over a period of 3 months. CBT skills were evaluated at pre-, mid- and posttraining/wait using assessor competence ratings of recorded therapy sessions. Hierarchical linear analysis revealed that the IBT-S participants had significantly greater CBT competence at posttraining than did IBT-CW and DT participants at both the mid- and posttraining/wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training DTs. IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more-traditional "live" methods of training. There was no evidence for a significant effect of IBT without supervision over a nontraining control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice. (PsycINFO Database Record

A Cognitive Behavioral Therapy-Based Text Messaging Intervention Versus Medical Management for HIV-Infected Substance Users: Study Protocol for a Pilot Randomized Trial.

BackgroundEvidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise.ObjectiveMobile phone–based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders.MethodsWith user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users.ResultsThe intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year.ConclusionsThis investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users.